Transparency of Transition from 2.75 mm to 1.8 mm Microincision Surgery

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Transparency of Transition from 2.75 mm to 1.8 mm
Microincision Surgery

• Jay McDonald II, MD
• Adjunct Clinical Professor
• University of Arkansas School of Medicine

Financial Interest AcuFocus, Addition
Technology, Advanced Vision Science, Alcon
Laboratories, Bausch Lomb, Ophthalmic
Innovations Intl.
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Purpose

• To evaluate the Stellaris Vision Enhancement
  System for transition from 2.75 mm to 1.8 mm
  microincision phacoemulsification surgery

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Field Observation Study (FOS)

• The Stellaris Vision Enhancement System to
  perform phacoemulsification cataract extraction
• 50 sites (2,000 cases) USA, Europe, and Asia
• 20 cataract procedures per group
• Surgeon experience questionnaire
• 11 procedures (small and microincision) data
  presented here

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FOS-Method

• Surgery techniques
• Standard coaxial
• Coaxial micro-incision cataract surgery (C-MICS)
• Biaxial (bimanual) micro-incision cataract
  surgery (B-MICS
• Consistency all eyes implanted with the SofPort
  Advanced Optics IOL (LI61AO)
• Operative assessments fragmentation,
  followability and holdability of nuclear
  fragments, chamber stability and instances of
  surge, as well as changes to technique
  necessitated by the change from a 2.75 mm to 1.8
  mm incision
• Measures
• Average phaco power (APP)
• Average phaco time (APT)
• Equivalent phaco time (EPT)
• Case time
• BBS used during case
• Corneal clarity on the first postoperative day

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Stellaris versus Millennium
  Phaco EPT APT Phaco Vacuum mm Hg IA Vacuum mm Hg Bottle Height BBS Total Phaco/ IA Time
Stellaris (1) 20 005.24 025.98 75 (max 200) 50 (max 600) 140 cm 68 cc 6 min.
(2) 22 003.93 003.93 130 (max 200) 375 (max 600) 140 cm 76 cc 4 min.
(3) 17 001.58 009.26 75 (max 200) 250 (max 600) 140 cm 81 cc 6 min.
(4) 36 018.41 050.58 75 (max 200) 140 (max 600) 140 cm 143 cc 7 min.
(5) 19 004.64 023.71 80 (max 200) 130 (max 600) 140 cm 92 cc 6 min.
Mature Cut (6) 32 024.55 116.74 60 (max 200) 120 (max 600) 140 cm 178 cc 13 min.
Millennium (1) 11 0051 0005 78 (max 170) 270 (max 550) 120 cm/110 cm 200 cc 4 min.
(2) 12 0027 0003 116 (max 170) 215 (max 550) 120 cm/110 cm 180 cc 4 min.
(3) 5 0020 0001 110 (max 170) 220 (max 550) 120 cm/110 cm 180 cc 4 min.
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Postoperative Results

• Physician efficiency faster real time surgery
  with Stellaris vs. Millennium (09.80 vs.
  032.70)
• Stellaris uses 41 less BBS during the procedure
  (Mean106.4cc vs. 186.7cc)
• Less fluid irrigated through the patient's
  anterior chamber reduces the endothelial cell
  exposure to the irrigation turbulence
• Less endothelial cell damage reduces corneal
  stromal edema during the immediate (POD 1), and
  mid-range (POW1) post-operative period

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Surgical Efficiency

• Stellaris uses 31 less phaco vacuum than
  Millennium
• Increased "purchase" efficiency during the
  emulsification of the nuclear segment
• Greater "cutting efficiency" during the procedure
• More efficient vacuum fluidics increases chamber
  stability
• Reduces fluid turbulence which may cause corneal
  endothelial cell trauma
• Stellaris Z average41.36 mm Hg max of 200 mm Hg
• Millennium Z average 59.7 mm Hg max of 170 mm
  Hg
• Stellaris uses 25 less I/A vacuum than
  Millennium, during aspiration of the lens
  cortical remnants and viscoelastic
• Increased fluidics efficiency
• Less turbulence
• Less potential endothelial cell damage
• Stellaris Z average177.5 mm Hg max of 600 mm Hg
• Millennium Z average 235 mm Hg max of 550 mm Hg

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Personal Experience

• Seamless transition from 2.8 mm to 1.8 mm phaco
• The smaller hand piece improves my
  maneuverability within the eye with no loss of
  cutting efficiency
• My phaco times have decreased 10 percent and
  fluid as well as power in the eye has continued
  to decrease with time

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Post Op Outcomes

• Nuclear fragmentation, followability, and
  holdability were judged excellent
• No instances of surge were reported to date
• Phaco power and case time were low
• Corneal clarity at Day 1 postoperative exam was
  judged excellent

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Conclusion

• The Stellaris Vision Enhancement System supports
  a wide range of phaco procedures, and has
  incorporated fluidics and power innovations that
  allow surgeons to segue smoothly to microincision
  phaco
• To date, the move to microincision phaco appears
  to be very straightforward, and patient outcomes
  have been uniformly excellent